| NPI | 1467412742 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD073233L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 201443) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2014-08-27 |